Claim Case Example (Domestic Insurance Policy)

The importance of F&R and adjustments.

An insured lodged a claim for a faulty ducted air conditioner at their premises. The fault occurred after cyclone Alfred caused a tree branch to fall on power lines in the area (power surge). The insured contacted a repairer who confirmed the damage and supplied a replacement quote to the insurer. The insurer accepted the claim and requested an F&R (Fair and reasonable) on the submitted quote. An assessor viewed the quote and determined that the repairer had quoted on a larger capacity (kw) unit. An equivalent size unit was then estimated by the assessor which lowered the claim amount as per replacement policy conditions. The report was submitted to the insurer for consideration. The claim was settled based on F&R report.

Claim Case Example (Business Machinery Breakdown Policy)

The importance of terminology and validation.

A butcher (the insured) lodged a claim for a faulty cool room. The insured had the cool room repaired and submitted the invoice for settlement. However, the repairer noted that the compressor (faulty part) had failed due to wear & tear (“compressor worn”) The claim was listed for a decline as the policy does not cover wear & tear. An assessment was requested by the insurer to validate the decision. The assessment, however, confirmed that the repairer had used the wear & tear terminology incorrectly and that the compressor had failed due to machinery breakdown. An assessment report was submitted, and the claim was settled.

Warranty Report Example (Floorcare Warranty)

A client requested a warranty claim for their 12 month old stick vacuum cleaner. The client advised that they noticed the vacuum wasn’t sucking up a lot of dirt as per usual. Furthermore, the client noticed the brush roller in the power head would not spin as fast as before. A technician inspected the unit and found carpet fibers had built up between the brush roller end and roller cog. The carpet fibers were removed, and the roller was cleaned. Once put back together the roller was spinning at a satisfactory rate and dirt was being sucked up properly into the canister.

Warranty Report Example (Floorcare Warranty)

A client requested a warranty claim for their 4 month old barrel vacuum. The client advised that the machine had loss of suction and was making a high pitched sound. The client had become dissatisfied with the brand and requested repairs or their money back. A technician inspected the vacuum and confirmed that a small sock had become lodged in the hose. The technician also noticed that the filter was full of debris. With the sock removed and a test filter in place, the vacuum was working correctly. The client was advised that the fault was not due to defects in materials or workmanship.